=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184734600
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDWARD SYRACUSE DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 SOUTH BEDFORD ROAD SUITE 201
-----------------------------------------------------
City | MT KISCO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10549-3439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-666-3300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 SOUTH BEDFORD ROAD SUITE 201
-----------------------------------------------------
City | MT KISCO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10549-3439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-666-3300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 030291
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------